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SYSTEM
TOPIC OUTLINE
I. Gastrointestinal tract
a. Anatomy
b. Physiology
c. Digestive process
d. Neural control
II. Signs and Symptoms of Gastrointestinal
disorders
III. Gastrointestinal disorders
IV. Pain patterns
GASTROINTESTINAL TRACT
Upper GI
• mouth, esophagus, stomach
Middle GI
• small intestine (duodenum, jejunum and ileum)
Lower GI
• large intestine (cecum, colon, rectum)
Accessory organs
• salivary glands, liver, gall bladder, pancreas, spleen
DIGESTION PROCESS
a. Mastication
b. Deglutition
DIGESTION PROCESS
a. Mastication
Muscles of Mastication:
Temporalis
Medial Pterygoid
Masseter
Lateral Pterygoid
Chewing reflex
DIGESTION PROCESS
b. Deglutition
Stages of Swallowing:
Pharyngeal
• initiates • involuntary
swallowing • involuntary (pharynx to
process (pharynx to stomach)
esophagus)
Voluntary Esophageal
STOMACH
Motor functions:
1. Storage of food
2. Mixing of food with
Gastric juices:
Cholecystokinin
Gastrin
HCl
Pepsin
Intrinsic
factor
Pancreatic enzymes
SMALL INTESTINE
Movements of small
intestine
1. Mixing contractions –
Segmentation
2. Propulsive movements
LARGE INTESTINE
Principal functions:
1. Absorption of water
and electrolytes from
chyme to form solid
feces
2. Storage of fecal
matter
ACCESSORY ORGANS
a. Salivary glands
b. Liver
c. Gallbladder
d. Pancreas
e. Spleen
SALIVARY GLANDS
Functions of Saliva:
1. Lubrication
2. Bactericidial
property
Major types of
secretions:
1. Ptyalin
2. Mucin
LIVER
Bile: mixture of water, bile salts, cholesterol,
and the pigment bilirubin
Emulsification of fats
LIVER
GALLBLADDER
PANCREAS
SPLEEN
NEURAL CONTROL
Enteric Nervous System:
controlling gastrointestinal movements and secretion
Vasovagal reflex
Controls secretions and motility of the GI tract
NEURAL CONTROL
Reflexes:
Gastrocolic reflex:
Enterogastric reflex:
Colonoileal reflex:
SIGNS AND SYMPTOMS
ABDOMINAL PAIN
1. EPIGASTRIC REGION
T3-T5 sympathetic nerves
ORGANS:
Heart
Esophagus
Stomach`
Duodenum
Gallbladder
Liver
ABDOMINAL PAIN
2. PERIUMBILICAL REGION
T9-T11
ORGANS:
Small intestine
Pancreas
Appendix
ABDOMINAL PAIN
3. HYPOGASTRIUM
T10 – L2
ORGANS
Large intestine
ABDOMINAL PAIN
REFERRED PAIN
ORGANS REFERRED TO
Esophagus Mid-back
Liver, diaphragm,
Shoulder
pericardium
Gallbladder, stomach, Mid-back and scapular
pancreas, small intestine region
Complications:
fluid
and electrolyte imbalance
pulmonary aspiration
GI damage
DYSPHAGIA
choking, coughing, or abnormal sensations of food
sticking in the back of the throat or esophagus
Causes:
GI Causes:
Non-GI Related:
Heartburn
Caused by reflux gastric contents into the
esophagus
Symptoms:
Bitter or sour taste in the back of the throat
Abdominal bloating
General abdominal discomfort
Complications:
Electrolyte imbalance
Dehydration & thirst
Dizziness
Weight loss
Precautions:
Handwashing, gloves, extremely careful cleaning of bathroom
and linen
CONSTIPATION
Factors that can trigger constipation:
Diet lacking in bulk and fiber, stress, inadequate fluid
consumption, sedentary lifestyle, increasing age and
drugs, muscle guarding and splinting
Obstipation
Intractable constipation with resulting fecal
impaction, retention of hard dry stools in the rectum
and colon
Melena
Bloody diarrhea
Reddish/Mahogany-colored stool
Clinical manifestations:
Fever,night sweats, lower abdominal, pelvic and
back pain or pain referred to the hip, medial thigh
or groin, or knee, antalgic gait
OBTURATOR OR PSOAS ABSCESS
Screening Tests:
Heel tap
Hop test
Lifestyle Modification:
Avoidance of large meals and certain foods
Do not eat 3 hours before bedtime
Sleeping position:
HIATAL HERNIA
LES becomes enlarged, allowing the stomach to
pass through the diaphragm into the thoracic cavity
Acute or Chronic
Symptoms:
Stomach pain
Bleeding
Nausea
Vomiting
GASTRITIS
Management:
Dietary modification
PPIs
H2 blockers
Antacids
PEPTIC ULCER
Loss of tissue lining in the lower esophagus,
stomach and duodenum
PEPTIC ULCER
GASTRIC DU
CAUSE NSAID H. PYLORI
Empty stomach,
Aggravated by food
PAIN between meals,
intake
early morning
VOMITUS Bright red, coffee ground emesis
STOOL Dark tarry stool
PEPTIC ULCER
Signs and symptoms:
Heartburn
Night pain, ® sh pain
Lightheadedness
Nausea, vomiting (coffee ground)
Anorexia, weight loss
Bloody stools
Black tarry stools
PEPTIC ULCER: MX
Treating H.Pylori : Antibiotics
Dietary modification
MALABSORPTION SYNDROME
Problems in intestinal absorption of nutrients
S/Sx:
Anorexia
Weight loss
Abdominal bloating
Pain and cramps
Indigestion, diarrhea
Steatorrhea (fats in feces)
MALABSORPTION SYNDROME
DEFICIENCY EFFECT
Intervention
Stressreduction
Regular physical activity
DIVERTICULAR DISEASE
Diverticulosis
pouch-like herniations of the colon
Diverticulitis
Inflammation and infection of one or more diverticula
DIVERTICULAR DISEASE
S/Sx:
(L) lower abdominal/pelvic pain and
tenderness
Loss of appetite, nausea, abdominal bloating
Bloody stools
Low grade fever
PERITONITIS
Inflammation of the peritoneum
s/sx:
Local irritation, pain, rectal itching
HEMORRHOIDS
Management:
Topical medications
Dietary changes
Sitz baths
Causes:
Unknown
Chronic alcoholism
Diuretics
viral infection
PRANCREATITIS
ACUTE PANCREATITIS
Epigastric pain radiating to the back
Nausea, vomiting, diarrhea
Abdominal distention and pain
Fever and sweating
Malaise, Weakness
Bluish discoloration of abdomen or flanks (severe
hemorrhagic acute pancreatitis)
PRANCREATITIS
PRANCREATITIS
CHRONIC PANCREATITIS
• Epigastric pain radiating to the back
• Constipation
• Flatulence
• Weight loss
HEPATIC AND BILIARY DISEASE
LIVER GALLBLADDER
Jaundice Jaundice
Bruising Low grade fever
Spider Angioma Belching
Palmar erythema Flatulence
Nails of Terry Fatty food intolerance
Dark Urine Mid-epigastric pain
Light-colored stool (R) upper abdominal
Ascites pain
Hyperreflexia Ant. Rib pain (tip of 10th
• Symptom
• often asymptomatic
Classic symptom:
• (R) upper quadrant pain that comes and goes in waves
• Pain peak and fades away
CHOLECYSTITIS
Blockage of gallstones in the CYSTIC DUCT leading to
infection and inflammation of the gallbladder
“HOT RIB”
Tenderness over the gallbladder
Steady and severe pain
CHOLANGITIS
Gallstones lodged further down in the system in the
COMMON BILE DUCT
(+) JAUNDICE